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Our rapid mental health service saves lives

Dealing with patients with mental health problems in South Durham, I became concerned about the long waiting lists for support services. In some cases, patients were waiting months after I referred them.

A combination of dwindling investment in mental health and the desperate levels of deprivation in the area contributes to the North-East of England having the highest rate of suicide in England. So to access better support for patients, my practice took part in a pilot set up and run by South Durham Health Community Interest Company (CIC), which put community psychiatric nurses (CPNs) into GP practices to work with patients with mental health needs.

Funding the pilot

As chair of South Durham CIC, a federation of 24 GP practices in the region, I helped bid for transformation money from our CCG. The pilot began in June 2014, when we employed two CPNs to work between my practice in Newton Aycliffe and two others in the town. It cost £54,000.

Now, a patient who has mental health needs, but is not in a state of crisis, can be referred directly to a CPN, in most cases within 24 hours. The nurses are highly trained and experienced in dealing with mental health conditions. As well as providing CBT and counselling, they can help patients with difficult issues such as bankruptcy hearings and employment tribunals.

If the CPNs deem a patient to be a risk to themselves, they can then direct them to more appropriate services.

In April this year, South Durham Health CIC tapped into a separate pot of funding to extend the pilot for a further six months. This gave surgeries in neighbouring Easington, Blackhall and Thornley access to three more CPNs.

Rapid access

We do not advertise the service in waiting rooms or on practice websites because it’s important not to encourage patients to think about harming themselves. However, we offer patients a same-day appointment at our surgery and the GP can refer the patient to a CPN on that day.

Most of the funding goes to paying the CPNs. We were lucky that CPNs can retire at 55 with their pension, but can still work two days a week with us. Other practices seeking extra mental health support for patients could employ a CPN two days a week for £24,000-£27,000.

It’s imperative that the right CPN is chosen for the job. The CPNs in our practice underwent mandatory training before they started work, completing the ASIST suicide-prevention course and training on the practice computer systems.

Encouraging results

The pilot has seen 173 referrals so far and it has reached 44,000 patients.

A total of 16 patients so far have been prevented from self-harm or suicide by the pilot. These patients had not initially been deemed to be in crisis, but their mental health had deteriorated. Had the pilot not been in place, these patients might have been on long waiting lists or unable to access help at all.

GPs in my practice now spend much less time following up mental health referrals. South Durham Health CIC is hoping that further successful funding bids will give all 24 practices in the group access to the scheme. It’s estimated that a suicide costs the health service £1.76 million and this scheme is an excellent way to start addressing this.

Dr Robert McKinty is a GP in Newton Aycliffe and chair of South Durham Health CIC

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Readers' comments (11)

Very noble.Use the funding , if available,appropriately , you get the results.I will say the same philosophy applies to physiotherapist , talking therapist/counsellor etc. Ideally , these are to be shared by several practices. Yes , this way of using funding does not earn you a headline in tabloid papers and policy makers , stakeholders must be honest to themselves....

In my area CPN's do not work weekends ... and the greatest pitfall in mental health care system is that when you really need help and support ... mental health care is only available during 'office hours'!

Patients should be able to make an appointment with a psychiatrist, in the same way that they do to see a a GP, it must be the only service where the doctor decides if he / she wants to see the patient, no matter what the crisis!

If CPN's are that good at their job, why do we need psychiatrists anyway?

My old practice had a similar set up in the early 1990s when fundholding was in full swing. We had in-house sessions with a consultant psychiatrist, a clinical psychologist, a CPN and a counsellor. It worked brilliantly, but ...er.... what happened then? A general election, change in government and all that good work was rapidly swept away.... Be warned!

Dr McKinty has managed to put aside funds for a further 12 months of the project, so it might just survive the change of government. But the funding is "brittle".Is this a throwback to Fundholding? perhaps. But perhaps it should be, since in most cases fundholding worked so well.